In 2012 experts estimated that 25 million Americans were addicted to alcohol, and that some 60 million more chronically used alcohol abusively. Out of this total of approximately 85 million addicted or abusing alcohol users, only some 2 million of these had treatment. Alcohol abuse disorders become costly health care expenses. The side effects of alcohol addiction impact health, family, careers and the culture. The new American national health care guidelines will mandate “evidence based“ treatment strategies for this problem. It is cost-effective to treat alcohol addiction.
Alcoholism is a chronic disease of the brain. It is genetically linked and becomes a neurological disease state with consistent high exposure. Monkeys bred for addictive genes will become easily addicted to alcohol. Those without the addictive genes can also become enamored to alcohol. It just takes more exposure. The risk for addiction appears to be about 50% genetic and 50% environmental. Daughters of alcoholics have a 15% risk of alcohol addiction, while the risk for boys is 30%. Once an addictive pathway is established, it does not go away. Even after periods of abstinence, it may be easily reestablished with use. Chronic, excessive alcohol exposure causes permanent changes in gene expression and neurotransmission. It is also gradually neurotoxic and can lead to alcohol related dementia.
People who grow up in families and cultures that promote alcohol have a greater risk of addiction, as are those who are characteristically impulsive, self-centered, lack spiritual development, and tend to seek immediate gratification. Unfortunately, many alcoholics have had biochemical alterations in neurochemistry that have shifted feelings and personality into a posture of self destructive intransigence, that is characteristically dishonest with self and others. They are often habitually using denial and projection in defensive emotional reactivity. Alcohol experts emphasize that alcoholics are not responsible for their genetic vulnerability, but they are responsible for their behavior, including alcohol use. Recovery programs in America are widely available and free.
There is a high co-occurrence of psychiatric disorders with alcohol abuse. It is important that the psychological aspects of alcoholism are treated along with the addiction. For instance, depression increases the chance of a return to alcohol abuse in a recovering person. Bipolar disorder is 6 times more likely in alcoholics. Alcohol is know to be highly dysregulating to the sleep cycle, typically fragmenting sleep and disrupting sleep stages. Sleep of course is a critical factor in many brain and body functions, one of which is emotional equilibration. Chronic sleep disruption poorly impacts heart and immune function, brain health, and complex thinking skills including memory and learning which primarily happen in sleep.
Alcohol abuse not only damages the user, it damages the people in close relationship. Alcohol unleashes the aggression circuitry. A monkey or a rat is more aggressive with alcohol intake.The disinhibiting impact can lead to poor judgement or abusive behavior. Risk taking, aggressive reactivity and impulsivity may become established patterns with long term abuse. Living with a dysregulated person is dysregulating. Too often, family members learn to follow the “no speak rule”. Protestation is met with angry outbursts or punishment of one sort or another. Relationships lose the intimacy of communicative exchange and kindly collaboration of differences.
Important facets of therapeutic and medical intervention include: helping the alcoholic to consider change, accepting progress in incremental gains, exploring past successes and delineating future goals, confronting fears, and determining where in the change continuum they presently stand. A new technique, called motivational interviewing, attempts to skillfully collaborate with the part of the addictive person that is willing to change, building in small behavioral and cognitive shifts towards a clear thinking, sober life. Outlining the good points in the status quo and the negative factors related to the use of alcohol may be help to incentivize a start in the process of achieving and maintaining sobriety.
Finding ways to sooth craving and upset without alcohol is another part of an effective program design. Listing precise alternative behaviors to alcohol consumption is important, as is scheduling regular pleasant activities that don’t segue into alcohol euphoria - a momentary experience with a high price tag. Selecting pleasurable behaviors that can be openly and honestly shared with others will help to avoid the inescapable element of dishonesty that is part and parcel of alcohol addiction.
Habitual self scrutiny that examines personal identity and its social components may be helpful in moving from a habitual drinker to a nondrinker. It means a change in life habits, friends and social context. Identifying social and emotional triggers with a strategy for coping with them sans alcohol is also smart. Understanding the liabilities of alcohol abuse and the assets of a moderated lifestyle can be a step forward towards self respect. The intentional self regulation of negative emotional states is essential for a satisfying, productive life. Thinking about thinking is important for anyone, but particularly for someone who has been regularly abusing alcohol. Addictive behavior is reflexive and automatic. Moving from reactive to reflective is one of the immeasurable benefits of sobriety and thoughtful living. Increasing self control comes with a sense of personal competency and empowerment.
The best research proven treatment guidelines for alcohol addiction have been those formulated many years ago for physicians. The effectiveness of this treatment protocol seems to be in two demand characteristics. One is documented on going addiction treatment care, and the other, also an accountability factor, unending intermittent urine tests set up randomly and unannounced. An addicted physician will lose medical licensure should there be a relapse. Setting up accountability and consequences for a non-physician patient is a bit more challenging. It could involve family members, documented treatment attendance and psychotherapy, and more physician visits with blood/urine tests.
The new American health care will require more early intervention and medical treatment with psycho/social components and possible medication assist for craving and relapse. Family physicians will be trained to integrate addiction diagnosis and treatment into their practice. It is hoped that this will make treatment accessible to more Americans. Using prescription drugs to lessen craving and decrease dangerous and dysregulating detoxification, increases treatment success. Sometimes the temporary use of long acting benzodiazepines and opioid antagonists is necessary to avoid the acute physical symptoms of withdrawal.The long acting benzodiazepines help to decrease symptoms of sudden abstinence and stabilize potential central nervous system dysregulation. Opioid antagonists insure that there will be little or no reward found in drinking alcohol. While depression during alcohol withdrawal needs to be addressed, research indicates that antidepressants do not seem to help with abstinence. Recent studies have found that mood stabilizers, particularly Topiramate, promote abstinence more effectively than antidepressant medications.
While alcohol abuse is virulent in America, we do know more about how to treat it effectively. As mentioned, guidelines for intervention will be mandated in the new health care policies, and more people will have access to alcohol addiction management through their family physicians. Successful alcohol treatment and alcohol awareness is a way to teach people to integrate measured pleasure into a productive lifestyle, without the instant relaxation and momentary euphoria of substance abuse. It entails learning to establish a new lifestyle that reflects higher values, long term goals and self sovereignty.
- Dr. Linda Klaitz, Medical Psychologist